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I <br />~iJrEIl~~ .tea--~PJ~i3~! <br />-;-~ <br />MINE REPORT ~.. <br />Note-Please Sll oat this report carefully, write plainly and answer all questions fully. Be sure to <br />date the report and sign it. oat both sides of the sheet. C~~ ` ^ /~/ <br />-- --'~'~-------. Colorado, i/~__-F ~ ---~ 19 ~_"/ <br />BL'RliAli OF 1lfLtiES, STA COLORADO. r <br />T. R. Henahen, Commissioner of 3fines, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised Stntntes, Colorado, 1908, I submit report as follows: <br />(Name of Company-The---------------------------------~------------------------ <br />------ <br />_- iIncorporated in the State of____________-_.___ _ _________________________ <br />--- - I <br />'Principal office ------------------------- -------- -- --------------------------. <br />(Capital sloe's ___________________.____Shares, nt $________.___ Per share. <br />1! c ComVN7• <br />ml °~t ml. ~ Name P. 0..lddresses <br />Ivurt I: Llauk . <br />;President -- - -- --- --------- -------- - --- - -------------------- -- .-- <br />~ur shift. <br />iurshift. (Secretary -.---------- _---_------__..------__..__-- <br />iursbift. ~Treneurer .- ----------------------- ------ ----- ----------- ---------- - <br />--- <br />rurshift. '.Manager ___-- ~ _-~_-- -- --~~-----.--.- ..-- <br />------------------ <br />rursbift. - <br />-- <br />rurshift. IStle of Pnrtnerehi -._______._ __ _________-__ _..._ __.-__ <br />(~ p---- ----- - <br />-- -- <br />lur shift, i Partn • ~~' .' I n~•~< 0- lddress <br />~/'~ .; <br />lur shift. ~. a ~ P/ ~.-Q ~k~'Gl~-ar-Lc~c..r~ -. <br />,/ .--- -~ <br />lurshift. ~ C'~li1~/ ____ __, ~C9-o <br />-r <br />----.. <br />-- - _ - <br />r.. n.m <br />lur shift.. °, u+~~~•rnulp. ' _ •1 <br />qni otLmriN <br />I au It LI nk <br />______ <br />- -- - ~Iauuger t~~ ~ ~ _ -~iq~tn-.~-~[.~E .~'~a, <br />'- '" r Nunes of Ownent 1'. 0. Addresses <br />----- i <br />I! untLn -------------------- - - ~- - - - <br />-'---" euupnn! uer <br />Voto•nidy. ____._____- <br />q~.v° I - . <br />I _- __ _ _____-_ <br />--- ~ unnger. _ _ _ -._ _ __ _ -- --_-.. _ ____-- <br />titn!~ uumen of claims: <br />-- <br />~ / Pa nted nputen e <br />in the jj- ~ ~ ~ <br />__-- -----.k_~~__ Ol.r'-L------ ---------------- <br />___.. <br />__---- ~/~~ <br />------'mil-=-'------------------------ -------------------------._-_.----------~- <br />_O~ r _..__-.. <br />-- --- /~ <br />----- -- L ------ - <br />_________acres; unpatented------------- <br />'fotal ucreage patented________________ ----- .acres. <br />npany. - ----- <br />------ <br />Do yuu own or lease these claimot_____ ----------------- "~ <br />------------- <br />1 <br />-~--- If yuu lenay them give name company or peno rom whom leaeed____---_..---- ~ --- -- ~'- --_ <br />--~~~ ~ (Over) <br />~~ <br />~~ <br />